Chaney says heterosexual counselors who haven’t walked the path of lesbian, gay, bisexual or transgender (LGBT) clients might not fully understand the significance of processing that experience. It’s important to gain that understanding, Chaney says, not only because counselors have an ethical responsibility to learn about diverse cultures, but also because at some point in their careers, counselors will almost assuredly come across clients who identify as LGBT, and they need to be prepared to work with this population.

“One of the most important things counselors can do [to prepare] is engage in the process of self-reflection on their own sexual orientation and gender identity,” says Chaney, an associate professor in the Department of Counseling at Oakland University in Rochester, Mich. “Until you understand your own sexual orientation and gender identity, there’s no way a clinician will be able to understand and work with an LGBT client.” He suggests that counselors think about what their sexuality means to them, how it influences their life and how it influences relationships with their clients.

“Part of the self-awareness is identifying one’s heterosexual privileges [and] understanding how that might affect the therapeutic relationship with clients who are not heterosexual,” Chaney says. One example is the privilege of marriage. For instance, a heterosexual counselor might display a photo of her husband in her office. “Something as small as that could influence the relationship, possibly making the client feel less than,” Chaney says. “I am not suggesting that counselors remove photos of spouses. I am just using that as an example that counselors need to recognize the privileges they may bring into a counseling session — the right to marry being one privilege. Because many heterosexual counselors do not typically feel the experiences of living in a heterosexist society, it is often difficult for them to recognize their heterosexual privilege.”

In addition to reflecting on their own experiences, Chaney says, “Counselors should put themselves into the LGBT communities and talk to LGBT folks to find out what their needs are, give LGBT people a voice and, after listening to the needs of these communities, advocate on their behalf.”

It’s also essential for counselors to understand that the LGBT community is diverse, Chaney says. “I think most people’s perception is that we’re one big homogenous group, but we’re actually a very diverse group, and we have very diverse needs and unique values.” The community does share a history based on oppression, however, which has led its members to develop a variety of coping skills. “It’s important to know that as communities, we’re a very resilient group of people,” Chaney says. “From a counseling perspective, that’s great information to have because we can use that resiliency in our counseling sessions.”

The ALGBTIC website (algbtic.org) is a good resource for all counselors, Chaney says. It offers a set of competencies for working with LGB clients, another set of competencies for working with transgender individuals and a host of other helpful tools.

Although counselors have a personal responsibility to learn more about the LGBT community, Chaney says counseling programs also have a responsibility to teach their students in a broader way. The existing requirement of a multicultural course doesn’t necessarily mean in-depth teaching on LGBT issues, he says. Depending on who is teaching the course, students might have a couple of class sessions focused on LGBT issues based on one chapter in a textbook, or LGBT issues might be infused throughout the course.

Chaney thinks training programs should provide more student exposure to LGBT communities, such as through internships in partnership with community organizations. He says research has shown that exposure makes the greatest difference in changing people’s attitudes concerning the LGBT community.

In the past, Chaney says, homoprejudice tended to be open and blatant, meaning it wasn’t uncommon for people to call LGBT individuals derogatory names to their faces. Today, the negativity is generally more covert, which Chaney contends can be even more damaging. It’s challenging, he says, because LGBT individuals are left questioning the meaning and genuineness of certain conversations and interactions. Counselors can see these effects, he says, in depressed, anxious clients who might be lacking self-esteem or struggling with substance abuse, for example.

But Chaney returns to the resiliency that historically has been a part of this group. “Tap into our clients’ strengths and the resilience of the community, and build up a client’s coping skills to better handle those types of situations,” he suggests.

Additional advice from Chaney: Don’t pathologize the client, don’t attempt to “cure” a client through reparative therapies, don’t assume the sexual orientation or gender identity of a client and, above all else, use affirmative counseling techniques that offer clients a safe, positive place.

All are welcome

When Megan Mahon, an assistant professor of counseling at Heidelberg University in Tiffin, Ohio, gives presentations to her fellow counselors on improving their interactions with LGBT clients, her first piece of advice is to start at the door.

“From the minute they come in, let them know that they are accepted, that they are welcomed,” says Mahon, a member of ACA. Drawing on three years of experience at the University of Toledo’s counseling center, Mahon suggests that counselors display “Safe Zone” stickers and include reading material in the waiting area from LGBT groups in the community.

The intake paperwork is also crucial in making a first impression, Mahon says, so it should feature inclusive language. For instance, instead of making “single,” “married” and “divorced” the only available options on paperwork, it could read “single,” “married or significant other” and “divorced or relationship dissolved.”

“It’s simple things like that, but they can make a big difference when clients are coming in [and] they’re scared and they’re not sure how they’ll be treated,” Mahon says.

Once a client gets into session, counselors need to be keenly aware of the language they use during the diagnostic assessment and make every effort to minimize heterosexual bias. Addressing whether clients are in a sexual relationship and how they identify are important parts of the assessment that often get left out, Mahon says. She suggests that a thorough evaluation might include assessing for sources of support, spirituality, history of violence or abuse, level of internalized homophobia, sexual history, sexual orientation, intimate partners and high-risk behaviors for sexually transmitted disease and substance abuse.

“The reality is, many counselors are not asking some of these questions — to heterosexual or sexual- and gender-minority clients — because it makes them uncomfortable,” Mahon says. “These are areas that you must be willing to explore if you are working with any population but especially with sexual- and gender-minority clients because they come to counseling with some unique experiences.”

Asking clients how they self-identify is a good idea, Mahon says, because this allows counselors to learn and use the same language that clients use to describe themselves. “We are prone to want to fit people into a box or category that makes sense to us, and we have been socialized to see men and women as behaving, dressing, speaking, etc., in a certain way. Counselors working with sexual- or gender-minority clients must be prepared to challenge some of their own preconceived notions about sex, gender and relationships and understand the client from their unique perspective.”

As is the case with many other clients, LGBT clients often come to session seeking help with relationship problems, whether family, social or personal, Mahon says. While working in the university counseling center, Mahon heard many stories about her LGBT clients coming out to their families and how their parents reacted by cutting off all communication, or how clients came out to a roommate only to have the roommate move out. “What a rejection,” Mahon says. “To come out to someone you think is your friend. You’re living in a small room with them and they [no longer] want to live with you or change in front of you. And then they say, ‘I’m moving out or you’re moving out.'”

LGBT clients might also present with occupational issues related to the risks of coming out at work. One of Mahon’s friends, a lesbian with a partner, revealed that during a recent job interview, she was asked whether her husband would be moving with her. The woman struggled with whether to answer yes and risk being caught in a lie later or saying no and having to come out to the interviewer on the spot.

Spirituality is another area in which LGBT clients seek assistance, Mahon says, because although their spirituality might be a meaningful source of support for them, many of these clients have also experienced rejection from religious communities.

Mahon also suggests that counselors be knowledgeable about addictions as well as HIV/AIDS and not shy away from engaging in conversations about those topics with LGBT clients. Both affect the LGBT community, and it can be helpful for counselors to assess clients’ risk factors and offer education, she says.

Mahon stresses the importance of counselors possessing a foundation in affirmative therapy to address the wide range of issues with which LGBT clients might present. Part of affirmative therapy is creating a welcoming physical environment in the counseling office, Mahon says, but beyond that, it also means avoiding harm to clients and focusing on offering unconditional positive regard.

With affirmative therapy serving as a base, Mahon says a host of other therapies can prove helpful in different instances with LGBT clients. In her work, she often integrates feminist, Gestalt and existential theories. Mahon likes the assertiveness component of the feminist perspective, as well as its demystification process, which encourages counselors to explain clearly to clients what they’ll be doing and working through together, thus eliminating any elements of possible surprise.

Although existential theory can be applied to all clients, it works especially well with some LGBT clients because it addresses their existential crises and the elements that give their lives meaning, Mahon says. “For a lot of us,” she adds, “getting married and having children is what gives life meaning.” Oftentimes, those options aren’t available to LGBT clients.

Mahon leans toward Gestalt techniques because LGBT clients can come to counseling feeling “split,” meaning they know who they are but have been told their whole lives that their identity and lifestyle is wrong. Helping them learn to accept themselves and feel whole again is important, she says, and Gestalt techniques can effectively address such issues.

Many counseling interventions are applicable to LGBT clients, Mahon says, even if counselors sometimes need to reconceptualize the approaches. She has requested that LGBT clients make genograms as homework so she can see all of their family members presented and then inquire what the relationship is like with each person. Mahon believes that Vivienne Cass’ identity model is also worth reviewing with LGBT clients. As homework, Mahon will sometimes ask clients to journal or make a collage about where they are in the identity model, where they want to be and how counseling can help.

Reflecting on her time in the campus counseling center, Mahon adds that group work can often be helpful. “Group counseling for LGBT students in a university setting is important because it not only provides a place for support and community, but it also gives clients a safe space for self-exploration. Developmentally, building a support network and self-exploration are things that most college students are working through. For LGBT students, this may be more of a challenge depending on the community they live in.”

Mahon suggests that counselors working with or planning to work with LGBT clients review a sexual orientation counselor competency scale. “An important part of the education and training considerations is how knowledgeable and how comfortable you are working with this population,” she says. Among her other recommendations: Visit the ALGBTIC website for resources, take advantage of professional development opportunities at conferences and workshops, keep up with research and journal articles, and get supervision from someone with experience. “Even if you’re no longer required to be under supervision,” she says, “it’s important to seek supervision when you’re working with a new group of people in general, not just LGBT clients.”

Taking a stand

Ask Erin Binkley why her work as a heterosexual ally to the lesbian, gay, bisexual, transgender, queer and questioning (LGBTQQ) community is so important, and she’ll share how it became crystallized for her one morning. A sexual minority high school student in a nearby community had died recently by suicide. Binkley describes the fallout from the event as “terrible,” adding that the reaction from parts of the community toward the student’s family was less than supportive. During her visit to a local dog park one morning, she started talking with a friend of the family.

“She came to the park terribly distraught,” remembers Binkley, an assistant professor of counseling at Oakland University and a member of ACA. “She looked at me with pleading eyes and said, ‘Where was the school counselor in this?'” In response, Binkley could only offer that, yes, in a perfect world, the school counselor would have been there to intervene. The encounter struck Binkley so deeply that it propelled her to do more than stand on the sidelines.

“I think back to that woman looking at me and the expression on her face when she asked, ‘Where was the counselor?’ and me, as a counselor, not having an answer for her,” Binkley says. “That was when I realized I wanted to be more involved in advocacy for this group.”

Binkley, who has been at Oakland since August, decided to join the LGBTQQ community as a heterosexual ally, an important role she says the community needs more people to fill. Binkley admits that when she first arrived on campus, she assumed being accepting of all races, genders and cultures was synonymous with being an ally to those groups. “What I started realizing was that being an ally means more than being supportive,” she says. “I had thought that if I wasn’t part of the problem, I was part of the solution. But being part of the solution means taking an active role in finding solutions. Not being against a certain group doesn’t necessarily mean I am for a certain group.”

As part of her commitment to getting more involved, Binkley is participating in a sexual orientation and gender identity initiative being implemented by Oakland’s School of Education and Human Services. “The idea behind it is to open the conversation about how we can be a more open and affirming community to people of all different sexual orientations and gender identities,” she says. As part of the initiative, lecturers are being invited to campus to speak on the topic. That exhibits greater acceptance to the entire campus, Binkley says, while also offering examples the LGBTQQ community can identify with and relate to. Moving forward, she says, the intent is to plan more events that inspire open discussions about LGBTQQ topics.

Binkley acknowledges that in the past, she thought LGBTQQ members had their own groups and that those groups held the responsibility of advocating for them. But the LGBTQQ cause can use help from the outside, she says, adding that she has realized she might have unique advantages that can help. “In this society, being a heterosexual person, I have an acceptance from the general population that is easy to take for granted. Being straight is the norm, and people for the most part probably won’t hate me for that. If a gay person goes out into society, that’s something they may have to worry about on a daily basis. I can use that advantage to take a stand.”

The LGBTQQ community has a variety of needs that heterosexual allies can help to meet, Binkley says. One of the most important is providing a “safe space” where LGBTQQ members can go to feel safe and accepted, she says. The need is present wherever counselors work, whether in agencies, schools, hospitals or elsewhere, she adds. Another substantial need is advocating for gay rights. “It’s really important to advocate for LGBTQQ people having the same rights that I have as a straight person,” Binkley says.

On the Oakland campus, students, faculty and staff can participate in a two-hour Students, Administrators and Faculty for Equality (SAFE) ally training to learn about accepting differences, how to talk to someone in need of help and other topics. Individuals who complete the training are given a rainbow triangle and their names are put on a list that is accessible through the university’s website. If LGBTQQ students need help, they can look on the list and might find that a fellow student down the hall or one of their professors is an ally to whom they can talk.

The ways in which counselors can serve as heterosexual allies to the LGBTQQ community might look different for each individual person and situation, Binkley says. But as general advice, she suggests that counselors join ALGBTIC as ally members. Next, she advises that counselors find out about the different types of LGBTQQ community support programs available in their localities and get involved. If there is a lack of community support, counselors can investigate what the needs are and get a support effort started, she says. Counselors on university campuses can take part in an ally training. And for school counselors, Binkley suggests considering the possibility of starting a group, perhaps for LGBTQQ teens or the parents of teens who identify as LGBTQQ.

For Binkley, becoming a heterosexual ally has meant taking part in and even initiating conversations about LGBTQQ issues with coworkers, identifying the needs in the community and seeking out other allies. Even when concrete answers aren’t available, Binkley says just getting involved in the conversation is a form of advocacy.

Counselors can let clients know they’re a heterosexual ally by something as simple as including sexual orientation and gender identity issues in a scope of practice or mission statement, Binkley says, while school counselors might include the topic in a brochure of services that they offer. “Tell your clients this is not something [you’re] afraid to talk about,” she advises.

Being an ally to the LGBTQQ community is in alignment with the foundation of the counseling profession, Binkley says. “By the nature of what we do, we want to offer a space for all people to come and be who they are. Counseling treatment, no matter what venue it’s in, rests on the assumption that people can come and talk openly and honestly about who they are and what’s going on in their lives. This is just another way to say this is a safe place.”

Beyond the open conversations and letting clients know they’re safe to be themselves, Binkley believes the advocacy that goes along with being an ally is also a natural fit for the counseling profession. “I think that is the mission of a counselor — to help people find their voices and to be that voice when someone can’t do it for themselves. We’ve advocated for groups that have been beaten down by society, and this is certainly one of those groups. I would hate to think that there’s a teen or an adult out there hurting themselves and that I could have made a difference but didn’t speak up.”

Same-sex parents

If you think parenting can be hard, take a moment to consider the pressures thrust upon parents who are in the spotlight because of their minority status as LGBT individuals. Jason Patton, a core faculty member at Walden University, did just that in researching same-sex-oriented fathers for his dissertation.

After interviewing five couples who were full-time parents to biological or adopted children under the age of 18, Patton says he found each of the men and their stories to be unique. At the same time, he says, recurring themes of struggle and success emerged, as did abundant opportunities for counselors to help. He believes much of his research on same-sex-oriented fathers can apply to other LGBT parents as well.

The first bit of advice Patton shares based upon his research is for counselors to leave their expectations at the door and to avoid anticipating that all same-sex parents will be alike. “I think it is easy for counselors to assume that once they have worked with one same-sex family, they know all there is to know about what might present itself in future counseling relationships,” says Patton, a member of ACA and ALGBTIC. “To me, this is dangerous territory.”

Counselors’ presumptions could prevent them from exploring clients’ true experiences and inhibit them from forging a true connection with clients, Patton says. “If I am only connecting with who I believed you to be, I may never be able to get past this and come to understand you to be who you are.”

Patton also says counselors should never assume a level of dysfunction in the family. “It’s not always that there’s an issue within their family,” he explains. “They might be coping with the stress of the environment and people not being ready to accept them.”

Patton recalls a couple who resorted to avoiding restaurants in one part of town because they sensed an increased level of scrutiny from members of the community. The family, composed of an African American father, a Mexican American father and their children of other ethnicities, became the focus of comments and stares when they went out to eat, and the parents explained to Patton that it was just too much for them to handle. “It’s easy to become overtaxed by always being aware,” Patton says.

Counselors working with clients feeling the weight of scrutiny can help them identify when they’re becoming overwhelmed and how it affects their life. Then, Patton says, counselors should support ways for clients to recharge and take care of themselves.

In doing his research, Patton discovered what he thinks is an important paradox. Despite almost all of the men saying they had anticipated marginalization but hadn’t noticed it much, in the next breath, Patton says, they would share experiences of overt discrimination or isolation.

“It would be easy for a counselor to say, ‘Oh, wait, you’re wrong. You said you don’t experience this, but I’m hearing you say you do,'” Patton says. But he doesn’t believe that’s the correct course of action. Instead, he suggests, counselors need to realize the paradox might be a self-protective mechanism. “To immediately lambaste this without fully thinking through the potential functionality of it could cause potential harm,” he says. “I think it’s OK to say, ‘I’m hearing a couple of different things. I just want to go there with you.’ Adopt a stance of curiosity instead of authority. Don’t take the expert role.”

The transition period that occurs when same-sex parents are waiting to adopt a child can be especially challenging. In his research, Patton found that working through the adoption system was incredibly stressful, particularly when the prospective parents anticipated being denied parenting rights because of their sexuality.

The time after the adoption goes through can also be challenging, in part because same-sex parents often lack role models to look to for guidance. One of Patton’s interviewees said it felt as though he and his partner were writing the rules as they went along. “They had good models of what it was to be a good parent,” Patton explains, “but they didn’t have models for how to negotiate roles in same-sex couples.” To help LGBT clients struggling with this transition, Patton says counselors should be well informed of resources within their local communities as well as books or movies that speak to the experience. Another important role for counselors is helping these clients feel understood and appreciated, he says.

Among the same-sex fathers he interviewed, Patton discovered another challenge that arose when they became parents — they often felt isolated from the greater LGBT community, effectively assuming minority status even within their own larger minority group. “When clients are cut off from their natural communities of resistance that have helped them to cope and manage negativity from society at large, they may feel demoralized and discouraged,” he points out. To assist these clients, Patton says counselors should model supportive, responsive and optimistic connection. Encourage clients to connect with other same-sex parents; even in isolated communities, that can be possible through social networking opportunities. Another strategy he recommends is helping clients identify the social support systems that are currently working in their lives.

Above all else, Patton says the role of the counselor with same-sex parents is to be supportive and to cultivate resilience that will help them rebound when they experience marginalization. “Identify psychological, emotional, familial and various other resources that clients already have in place,” he says. “These are, hopefully, things that have helped them succeed in the past despite any number of challenges. They are, after all, parents and lovers, so they have been doing something well. What has worked in the past, and what efforts are they currently making to persevere or excel? Ask how to best bolster these things. Validate and encourage, but also do not shy away from identifying those things that do not work or are counterproductive to the clients’ efforts.”

During his research, one of Patton’s most memorable experiences came when a gay man he interviewed, once stoic and unsure of his ability to be vulnerable, described finding and embracing his softer side after becoming an adoptive father. “He felt transformed by the experience and said he became a better man for it,” Patton says. “Too many same-sex couples might not think they’re able to be parents. There is this whole world that could be open to them if counselors, institutions and families supported them.”

A space for spirituality

Spirituality can be both an important and challenging topic when it comes to LGBT clients, says Robert Dobmeier, an assistant professor and coordinator of the mental health program in the Department of Counselor Education at the College at Brockport, a campus of the State University of New York. Dobmeier notes that he has engaged in many conversations on the topic with Brockport colleagues Summer Reiner, Kathleen Fallon and Elaine Casquarelli, and he offered to share some collective thoughts that have emerged from their discussions.

Dobmeier, an ACA member, points to a white paper on spirituality from the Association for Spiritual, Ethical and Religious Values in Counseling, a division of ACA, that states spirituality is “innate and unique to all persons.” Although religion is the institutional organization of common beliefs, spirituality can encompass personal aspects, including the search for love, meaning and hope. Religion is a major form of spiritual expression, he says, but the teachings of some religions have amounted to LGBT individuals being rejected by various religious communities.

“The individual is often forced to make a choice between practicing their sexuality and practicing their religion,” Dobmeier says. “This can cause distress in the individual, as well as self-doubt, resentment and anger. In reflecting on one’s life, the individual may feel positively about his or her developmental process that has culminated in an identity as lesbian, gay, bisexual or transgender. On the other hand, the individual recognizes messages and forces in the larger culture, and possibly from a religious community in which she or he has grown up, that deny the authenticity of one’s developmental experience.”

Likewise, LGBT communities can be a source of rejection for LGBT clients who wish to maintain their religious identity, Dobmeier points out. He explains that these clients might encounter antireligious sentiment within some LGBT communities because its members have been rejected by certain religious groups. This may leave the client feeling forced to choose between being accepted by an LGBT community that is hostile to religious involvement or remaining alienated as a member of the religious community, he says.

An additional source of stress can present itself if LGBT individuals fear retribution from God or have feelings of guilt due to religious messages that proclaim gay and lesbian sexual orientation as sinful, Dobmeier says. Tensions related to prioritizing one’s sexual practice or religious practice can also play out in a relationship with a partner, leaving one partner feeling dissatisfied with the other.

At the same time, spirituality as a search for meaning, hope and forgiveness, as mentioned in the ASERVIC white paper, can serve as a source of strength and wisdom for LGBT individuals who frequently cope with antagonistic cultural values and responses, Dobmeier says. Although LGBT clients may seek counseling for a variety of issues, if a client wishes to address spirituality, Dobmeier says counselors should be open to the experience of the individual and respond in a way that is therapeutic for the client. The ACA Code of Ethics ASERVIC’s Spiritual Competencies and other professional documents specify the need for counselors to be capable of responding to the client spiritually, Dobmeier says.

“In anticipation of this need, the counselor may want to reflect on where he or she is at spiritually,” he says. “Specifically, how have the counselor’s cultural and spiritual traditions of origin influenced how she or he might work with an LGBT client? Does the counselor’s spiritual or religious life bring healing in the life of the counselor that can be used in counseling an LGBT client?”

Dobmeier points to narrative therapy as helpful in working with LGBT individuals who want to explore aspects of spirituality because the approach invites clients to tell their stories. When they share their stories of their search for self and sexual identity, the difficulty of coming out, conflicts with family and rejection by religious and other communities, he says clients can find support from the counselor and potentially gain perspective on where they have been and where they want to go. Getting in touch with feelings of hurt, rejection and anger can also allow healing to begin, he adds.

Working with LGBT clients whose experiences with religious or spiritual communities have been negative requires that counselors listen carefully to these individuals’ stories, Dobmeier says. Counselors may find that clients are asking for assistance in deciding whether to change churches or religions or even exploring the possibility of ceasing religious practice altogether. Dobmeier suggests that counselors help these clients to recognize available options and provide support as they work through the decision.

Dobmeier’s overriding advice to counselors working with LGBT clients on spiritual issues: Educate yourself and remain open-minded. “The counselor can prepare for spiritual work with LGBT clients by becoming aware of one’s own spirituality, seeking knowledge about problems encountered by LGBT clients and being open to listening to the client’s story so as to understand his or her hurts and needs. The counselor should support the client in his or her search for identity, not make assumptions about what is best for the client in terms of his or her identity and facilitate the client’s making her or his own decision about sexual identity.”